Have you been concerned about high blood pressure (hypertension)? Or are you worried about an older relative having a stroke or heart attacks?

You’re not alone. After all, hypertension is the most common chronic condition among older adults, and medications for blood pressure (BP) are among the most commonly taken drugs in the US.

Even more important: poorly controlled hypertension is a major contributor to the most common causes of death and disability in older adults: strokes, heart attacks, and heart failure.

So it’s certainly sensible for older adults – and for those helping aging parents – to think about blood pressure.

And once you start thinking about high blood pressure, you’ll probably start to wonder.

Are the blood pressure medications you’re taking enough? Is your blood pressure at the “right” level or should you and your doctors work on changing things?

And what about that major research – the SPRINT trial — that made the news in 2015? (In this study, older adults randomized to aim for a lower BP did better than those who got “standard” BP treatment.)

These are excellent questions to ask, so I’d like to help you answer them.

Now, I can’t provide exact answers on the Internet. But what I can do is provide a sensible process that will help you successfully address these questions.

In this article, I’ll share with you the process that I use to:

Assess an older person’s blood pressure management plan, and

Determine whether we should attempt changes.

If you’re an older adult, you can use this approach to get started assessing your own BP management plan. This will help you to better work with your doctors on assessing and managing your blood pressure.

If you are helping an older relative manage health, you can follow these steps on behalf of your relative. [Read more…]

Recently, while I was at a family celebration, several people mentioned memory concerns to me.

Some were older adults concerned about the memory of their spouses. Some were adult children concerned about the memory of their parents. And a few were older adults who have noticed some slowing down of their own memory.

“But you know, nothing much that can be done at my age,” remarked one man in his eighties.

Wrong. In fact, there is a lot that can and should be done, if you notice memory or thinking changes in yourself or in another older adult. And you should do it because it ends up making a difference for brain health and quality of life.

First among them: identify medications that make brain function worse.

This is not just my personal opinion. Identifying and reducing such medications is a mainstay of geriatrics practice.

Unfortunately, many older adults are unaware of this recommendation. And I can’t tell you how often I find that seniors are taking over-the-counter or prescription medications that dampen their brain function. Sometimes it’s truly necessary but often it’s not.

What especially troubles me is that most of these older adults — and their families — have no idea that many have been linked to developing dementia, or to worsening of dementia symptoms. So it’s worth spotting them whether you are concerned about mild cognitive impairment or caring for someone with full-blown Alzheimers.

Every older adult and family should know how to optimize brain function. Avoiding problem medications — or at least using them judiciously and in the lowest doses necessary — is key to this.

And don’t give anyone a pass when they say “Oh, I’ve always taken this drug.” Younger and healthier brains experience less dysfunction from these drugs. That’s because a younger brain has more processing power and is more resilient. So drugs that aren’t such problems earlier in life often have more impact later in life. Just because you took a drug in your youth or middle years doesn’t mean it’s harmless to continue once you are older.

You should also know that most of these drugs affect balance, and may increase fall risk. So there’s a double benefit in identifying them, and minimizing them.

Below, I share the most commonly used drugs that you should look out for if you are worried about memory problems.

The Four Most Commonly Used Types of Medications That Dampen Brain Function

[The following question was forwarded to me by Nancy Stein, who addresses caregiving questions on her blog at SeniorityMatters.com.]

Q: My loving, Jewish mother is 92 and has turned into a rude, abusive foul-mouthed woman who I no longer recognize.

She’s in relatively good health and amazingly lives in the same house I grew up in. She has an aide during the day. She won’t leave the house,treats the aide poorly and last weekend cursed out my very patient spouse. We’ve been getting 5 calls as day such as ” I”m having a heart attack; no one will tell me whether recycling comes today”!

I know she has early signs of dementia. Her cardiologist tells me not to take it to heart and this is not the same women who raised me. She won’t go to the JCC adult programs, complains about being lonely at night, yet hangs up on me when I tell her we can get an aide at night or sell the home and let her live in a facility with women her age, etc. She threatens to call the Police if someone comes to her home at night. I have a POA but don’t want to rob her of her independence at 92. I try to tell her to speak nicely to the aides, myself, my spouse, but she says ” I don’t remember or I must have reacted to something someone did or said.”

I feel guilty as I’m not spending as much time with her as I would like, but it’s a matter of survival. Jewish guilt is thrown about with impunity and I can’t tell whether she’s being manipulative and obsessing over bullshit ( “oh my God the outside light may burn out tonight” ) or she really can’t control herself. Her aide is a lovely human being but my mom orders her around like a slave. Who is this woman? I’m torn, anguishing over what to do and am doing nothing but try to correct her inappropriate behavior and language. I wanted to take her to a geriatric psychiatrist but she refused to go. Medication to calm her down is dangerous per the MD as she could fall, etc.

What should I do? I’m at my wits end.

Dr. K’s answer:

Wow, difficult situation but unfortunately not uncommon.

You say your mother has early signs of dementia, and it is true that “personality changes” can be due to an underlying dementia, such as fronto-temporal dementia or Alzheimer’s, especially if a family notices other changes in memory or thinking abilities.

But it doesn’t sound like your mother’s been clinically evaluated for dementia, and you don’t say whether this has been brought up with her primary care doctor.

This question came up during a Q & A session, as we were discussing the Choosing Wisely recommendation to avoid tying down older adults who become confused during a hospitalization. (See item 5 in this article.)

Delirium is a common and important problem for all older adults in the hospital; it doesn’t just happen to people with a dementia diagnosis!

But many family caregivers have hardly heard of hospital delirium. This is too bad, since there’s a lot that caregivers can do to prevent this serious complication, or at least prevent an older loved one from being physically restrained if delirium does occur.

In this post, I’ll review what older adults and family caregivers absolutely should know about hospital delirium. And, we’ll cover some of the things you can do if it happens to your loved one. [Read more…]

If you want to prevent dangerous falls in an aging adult, here’s one of the very best things you can do: be proactive about getting the right kind of medical assessment after a fall.

Why? There are three major reasons for this:

A fall can be a sign of a new and serious medical problem that needs treatment. For instance, an older person can be weakened and fall because of illnesses such as dehydration, or a serious urinary tract infection.

Older adults who have fallen are at higher risk for a future fall. Although it’s a good idea for any older person to be proactive about identifying and reducing fall risk factors, it’s vital to do this well after a fall.

Busy doctors may not be thorough unless caregivers are proactive about asking questions. Most doctors have the best intentions, but studies have shown that older patients often don’t get recommended care. By being politely proactive, you can make sure that certain things aren’t overlooked (such as medications that worsen balance).

All too often, a medical visit after a fall is mainly about addressing any injuries that the older person may have suffered.

Obviously, this is very important! However, if you want to help prevent future falls, it’s also important to make sure the doctors have checked on all the things that could have contributed to the fall.

Even if you’re pretty sure your loved one just tripped and stumbled, a good evaluation can uncover issues that made those trips and stumbles more likely.

In this post, I’ll list eight key items that you can make sure the doctors check on, after a fall. This will help you make sure your loved one has had a thorough work-up, and can reduce the chance of future serious falls. [Read more…]

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The material on this site, including any exchanges in the comments section of the blog, is for informational and educational purposes only.

Any comments Dr. Kernisan may make regarding an individual’s story or comments should not be construed as establishing a physician-patient relationship between Dr. Kernisan and a caregiver, or care recipient.

None of Dr. Kernisan’s website or group information should be considered a substitute for individualized medical assessment, diagnosis, or treatment.